【罂粟摘要】竖脊肌平面阻滞用于机器人辅助冠状动脉搭桥手术术后镇痛的评价:一项随机安慰剂对照试验结果

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竖脊肌平面阻滞用于机器人辅助冠状动脉搭桥手术术后镇痛的评价:一项随机安慰剂对照试验结果

贵州医科大学    麻醉与心脏电生理课题组

翻 译：潘志军

编 辑：柏雪

审 校：曹莹

研究背景：

研究竖脊肌平面(ESP)阻滞是否能减少机器人辅助微创冠状动脉搭桥手术(RAMIDCAB)患者术后阿片类药物消耗、疼痛和术后恶心呕吐。

实验设计：

一项单中心、双盲、前瞻性、随机、安慰剂对照试验。

范围设置：

术后；一所大学附属医院的手术室、麻醉后监护室(PACU)和病房。

受试者：

64例患者通过左侧小切口接受RAMIDCAB手术，并纳入心脏手术后加速恢复计划。

干预措施：

手术结束时，患者在超声引导下在T5椎体置入ESP导管，随机分为0.5%罗哌卡因组(负荷剂量30 ml，3次追加剂量各20 ml，间隔6 h)或0.9%生理盐水组(相同给药方案)。此外，患者接受对乙酰氨基酚、地塞米松和吗啡自控镇痛等多模式镇痛。在最后一次ESP注射后和拔管前，通过超声重新评估导管的位置。在整个试验过程中，患者、研究人员和医务人员对分组分配采用盲法。

测量方法：

主要结局是拔管后24小时内吗啡的累计用量。次要结局包括疼痛的位置和严重程度、感觉阻滞的存在/程度、术后通气时间和住院时间。安全性结果包括不良事件的发生率。

结果：

干预组和对照组24小时吗啡消耗中位数(IQR)无差异，分别为67 mg(35-84)和71 mg (52-90) (p = 0.25)。同样，在次要终点和安全终点也没有发现差异。

结论：

RAMIDCAB手术后，在标准的多模式镇痛方案中加入ESP阻滞并没有减少阿片类药物的消耗和疼痛评分。

原始文献来源：

Danny Feike Hoogma, Raf Van den Eynde,Wouter Oosterlinck,et al.Erector spinae plane block for postoperative analgesia in robotically-assisted coronary artery bypass surgery: Results of a randomized placebo-controlled trial [J]. (J Clin Anesth. 2023 Aug;87:111088).

英文原文：

Erector spinae plane block for postoperative analgesia in robotically-assisted coronary artery bypass surgery: Results of a randomized placebo-controlled trial        

Abstract

Study objective: To investigate if an erector spinae plane (ESP) block decreases postoperative opioid consumption, pain and postoperative nausea and vomiting in patients undergoing robotically-assisted minimally invasive direct coronary artery bypass surgery (RAMIDCAB).

Design: A single-center, double-blind, prospective, randomized, placebo-controlled trial.

Setting: Postoperative period; operating room, post-

anesthesia care unit (PACU) and hospital ward in a university hospital.

Patients: Sixty-four patients undergoing RAMIDCAB surgery via left-sided mini-thoracotomy and enrolled in the institutional enhanced recovery after cardiac surgery program.

Interventions: At the end of surgery, patients received an ESP catheter at vertebra T5 under ultrasound guidance and were randomized to the administration of either ropivacaine 0.5% (loading dose of 30 ml and three additional doses of 20 ml each, interspersed with a 6 h interval) or normal saline 0.9% (with an identical administration scheme). In addition, patients received multimodal analgesia including acetaminophen, dexamethasone and patient-controlled analgesia with morphine. Following the final ESP bolus and before catheter removal, the position of the catheter was re-evaluated by ultrasound. Patients, investigators and medical personnel were blinded for the group allocation during the entire trial.

Measurements: Primary outcome was cumulative morphine consumption during the first 24 h after extubation. Secondary outcomes included location and severity of pain, presence/extent of sensory block, duration of postoperative ventilation and hospital length of stay. Safety outcomes comprised the incidence of adverse events.

Main results: Median (IQR) 24-h morphine consumption was not different between the intervention- and controlgroups, 67 mg (35–84) versus 71 mg (52–90) (p = 0.25), respectively. Likewise, no differences were detected in secondary and safety endpoints.

Conclusions: Following RAMIDCAB surgery, adding an ESP block to a standard multimodal analgesia regimen did not reduce opioid consumption and pain scores.

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